There’s no doubt that there are a lot of people going through tough times out there. We often see the impact of these tough time in our emergency rooms and clinics. Health care is increasingly being asked to consider how it might help with these ‘tough times’, and, to the extent that an answer is available, it inevitably involves providing some kind of service.
But what if the people who’ve been providing those services are no longer convinced that they’re what’s needed? How can we learn from them, and how might that change what we do? Today’s interviewee is Maff Potts who’s spent 20 years helping those at the sharp end of society and is convinced that what’s being provided is not what’s really needed.
Pritpal S Tamber: Hi Maff. The first time we spoke you told me that after 20 years of working on homelessness you felt the solution was a gigantic tee pee in a hospital foyer…
Maff Potts: Well not quite but sort of! I spent 20 years working with people living at the sharp end of society. I ran almost every kind of project – from homeless shelters to hostels to rehabilitation centres to domestic violence refuges. I realised that there was a distinct pattern amongst those people who managed to turn their lives around – they had friends and a sense of purpose. None of the services that I’d run focussed on these two things, especially not the friendship stuff. Instead, they were about finding housing and maybe a qualification.
Pritpal: So, what did you do with that insight?
Maff: Not much until it was accompanied by another insight. When the economic crash happened in 2008, I was running the biggest homelessness provider in the UK. Sky News shoved a camera in my face and asked me what I was doing for people who were losing everything in the crash. I gave some terrible fudge of an answer and on the train home wondered what my answer really was. I realised that I was doing nothing for those people until, that is, they’d lost everything: their home, their relationships, even their own minds. It was only then that was I able to help.
Pritpal: That seems pretty late.
Maff: Right. So, I spent years asking people where they go when their life starts to unravel. They gave me two answers: the doctor’s or Starbucks. I realised these were the two options in the public realm: a place that tries to fix you and a place that tries to sells you something. There wasn’t anywhere where people could go and just ‘be’. That gave me the idea for a third space. A place where you can just be, not be fixed or sold to, a place where you can just be rubbish alongside others like you. And a place where you might be able to make friends.
Pritpal: So, what happened when you brought these two insights together?
Maff: I launched Camerados and we set about making ‘public living rooms’, our attempt to create the third space I mentioned.
Pritpal: And what did you learn by making these ‘public living rooms’?
Maff: At first, we put staff in them and offered drinks, like a café. We soon realised that this created a power dynamic whereby people thought that staff and servers were there to do everything. So, we got rid of that and just focussed on creating spaces in all sorts of settings. We made living rooms in a college in Sheffield, a library in Blackpool, and a prison near Preston, to name a few. We also started to hear people use our company name as a noun. A man called Wayne was overheard saying to someone, “I’m not your friend but I’m your Camerado; I’ve got your back”.
Pritpal: Why was that so surprising? It’s your name, after all…
Maff: Yeah, but we just took the word from a poem and used it as our company name, we never gave it a definition. We asked Wayne what he thought a Camerado was and he said, “Well, it’s halfway between a stranger and a friend”. We asked him why it couldn’t just be a friend and he replied that with friends there is a compulsion and obligation to fix each other; that’s a heavy pressure. A Camerado was just alongside you for a while, he or she didn’t have to solve everything but just be there for a while.
Pritpal: So, you didn’t know what a ‘public living room’ was and you didn’t even know what your name meant! You’re totally making this up as you go. I love it. Let’s get to the hospitals…
Maff: We prototyped public living rooms in almost every setting imaginable in our first year – a prison, a library, a community centre, an art gallery, a shop, we even did a mobile one on Brooklyn Bridge in New York! But the place it really took off was in a hospital. We were invited to set up a living room in Blackpool Hospital to improve ‘patient experience’ and it really took off. Making sense of that now, I guess it’s because in hospitals there is a high concentration of people going through tough times. They need a space to just be. However, we learnt that to be noticed in such a huge clinical environment the living room needed to stand out.
Pritpal: Does this explain the teepee?!
Maff: Yes. Honestly, like many innovations we just thought it would be fun so we tried it. All we knew was that it needed to stand out and a teepee seemed as good an idea as any. We later learnt that people found it magical, it transported them out of the hospital vibe. Also, it created curiosity and so people were attracted to it. It being circular also seems to encourage conversations between strangers, somehow. We’ve also learnt that, although it’s inside the building, it feels outside so it’s both safe and an escape. All of this we found out afterwards; really, we just took a chance.
Pritpal: Totally. Making. It. Up. Anyway, what do you mean by the public living room really taking off and what did you learn in the process?
Maff: We learnt that we got it all wrong. We thought we were there for the patients but they were the third most regular visitors.
Pritpal: Third? Who were first and second?
Maff: Visitors and relatives were the second but by far the biggest group that used the ‘teepee living room’ was hospital staff – nurses and doctors who told us they needed an “escape”. They used it for short bursts. They came in before their shifts for inspiration or after to decompress. Amazingly, we even saw patients looking out for stressed-out surgeons – true story! It’s not something we have ever seen before. The teepee seemed to make the power dynamic dissipate, it became a place for humans, for equals.
Pritpal: Wow! So, the ‘tough times’ being had were more in the staff than the patients and their visitors? That’s pretty telling. How did the hospital leadership respond to this?
Maff: They liked it a lot. Staff welfare and retention is a hot issue right now in the NHS (National Health Service). Unsurprisingly for health care people, they were attracted to the quantitative data. We had 15,000 people using the teepee in three months, 50% of them being staff. We also left postcards in the teepee for people to fill in with whatever they wanted to say. Many of the people that did that were staff and we shared some of their stories – which were anonymous – with the hospital leadership. They weren’t used to this kind of unfiltered feedback and found it incredibly powerful. In our next phase of learning we’ll be looking at whether there has been a noticeable effect on staff sickness. Every health professional we have worked with is convinced there will be.
Pritpal: Fascinating. But what happened to the aim of improving patient experience?
Maff: That’s definitely happening. We pin the postcards on a washing line in the teepee to inspire others. We have hundreds of stories written by patients and relatives about the extraordinary challenges they’re going through, from receiving bad news to saying goodbye to a loved one, as well as all the good news and stories of recovery. Hospitals scream of tension and high emotion. We’ve found that the teepee was the only place people could go to reflect and connect with others during what is often a difficult time.
Pritt: All this makes me think the teepee is some kind of mental health intervention.
Maff: It probably is but, interestingly, when the teepee was used for Mental Health Awareness week – with signage outside and formal leaflets – visitor numbers plummeted. We think that when the teepee looks like a ‘formal’ intervention, people are less inclined to engage. Or it may be that people didn’t want to be associated with something for ‘mental health’. Either way, we’ve learnt that just providing a comfortable, human environment, some messages about being a Camerado and looking out for each other, and asking people to leave and read stories are the three elements needed to encourage connection and wellbeing. We don’t need to mention ‘mental health’ to have an impact on it.
Pritpal: That’s so interesting. But is all this a one-off? Is there something about the people of Blackpool that has made the living room specifically successful there?
Maff: We wondered that too but then the same kinds of results are coming in from our new sites in hospitals in Middlesbrough, Rotherham and Manchester. We have a hospital in Norwich coming online soon, as well as a hospital in Northern Ireland having a go.
Pritpal: Interesting. What about beyond health care?
Maff: The hospital work is only 50% of what we do. But we also don’t want to do the doing, if you see what I mean. We want the movement to grow organically, not be something that Camerados has to be contracted to deliver. With that in mind, we’ve created ‘a public living room in a box’, a literal box in which we’ve put everything we’ve learnt about how to do them. We’re seeing people request the box and set up their own spaces. Some are in cafes, some are in empty shops, some are in community centres. This way of growing is not a new idea, of course. Alcoholics Anonymous, for instance, use it and they have a long and strong history of helping people get through tough times. We’re doing the same only without the alcoholism, just the ‘tough times’.
Pritpal: Where are you seeing the box being used?
Maff: In towns all across the UK but also in a youth club in Sweden, a community centre in the US – in fact, we’re getting enquiries from all across the US. People want to do something different in their neighbourhoods. They know there is a need out there and we’ve got an option for them.
Pritt: I guess the next time Sky News ask the question you have an answer. There’s one last thing that hasn’t clicked for me, though – the connection between all this and having a sense of purpose. How does your work help with that?
Maff: We are creating spaces for people to be a Camerado, to look out for each other, a mutual thing. And when you look out for someone else it’s the biggest injection of purpose you can get. You get a hit of friends and purpose in one go. The best way to transform someone’s life for the better is not to help them but to ask them to help you. It’s counter-intuitive but next time you see someone struggling ask them to look out for you in some way – advice, a listening ear, a favour – and watch what happens. People come out of their own problems and within minutes are telling you to stop stressing. They feel valued, as though they have something to give, like they have a purpose.
Pritpal: Have you seen this yourself?
Maff: Yes, totally. I have even seen it in extreme situations when someone has told me that want to take their own life. I ask them to do me a favour and within ten minutes they are telling me to calm down, it’ll be ok, they’ve got this.
Pritpal: Fascinating. Well, thanks for sharing your work with me and best of luck with the box-fuelled movement.
Maff: Thanks for your encouragement and thanks for what you do too.
In health care, we often ask for the evidence. We inevitably mean some kind of study that looked at an intervention and assessed its efficacy. But the experiential knowledge of folks like Maff are also important – and often more so. The doctor inside me is aching to express his cynicism towards Maff’s claims and yet who am I to judge his work when he’s seen people going through – and, crucially, come through – tough times. His ability to distil it to two things – friends and a sense of purpose – combined with his desire to fuel a movement by sharing all that he’s learnt for free are impressive. And what he’s learnt about staff morale in the NHS reinforces the idea that we in health care clearly have a lot to learn.